Spinoff : What We Do, What We Used to Do

[NursingAgainstdaOdds]

The HIV thread reminded me of a thread I've wanted to start here for a while. (Apologies if it's been done!)

I love to hear accounts from experienced nurses about how nursing practice used to be, or how different practices have evolved. For example, an experienced traveller shared with me recently how patients with feeding tubes used to have what everyone else had - just pureed like crazy. (Interestingly to me, she also informed me that there was no such thing as a tube-fed patient with obligatory diarrhea. She felt this was because the patients got "real" food. I thought that was very thought-provoking.)

So, please share. Nursing history of all kinds really fascinates me. I wouldn't restrict this to practice-based issues, either - nurse/patient, nurse/doctor, nurse/nurse relationships have also evolved in fascinating ways. Let's hear it!

Edited to Add : I'm also interested if anyone has experiences which exemplify where certain procedural changes originated - i.e. our vigilance with IVs.

[plumrn, BSN, RN]

I remember doing C&A's (clinitest and acetest) on urine samples Qid, ac and hs. The results told us how much insulin on the sliding scale to give. Amazing to think about now!

I remember telling anyone, and everyone that called or asked about a patient, how they were doing without ever thinking about privacy, and amazingly never had a pt become upset that we did.

I remember doing colostomy care without gloves, 'because it will offend the pt' to do it with gloves on.

Besides, gloves were not as plentiful in those days, especially not available in every room.

I remember dressing up in full gown, mask and gloves before entering a pts room that had AIDS. We even kept a bottle of bleach in the ante-room to rinse our hands with after caring for them (which dried and cracked our hands so that we actually were making easier to transmit all kinds of bacteria).

I remember having enough help that we were able to take breaks AND lunch, and were able to complete our care and charting before it was time to go home.

We only had a few IV pumps on the floor and they were reserved for CHF'ers, medications drips, and the very young and very old. We 'stripped' our IV's with the time down the side with the expectant time to run out at the bottom. We pushed Aminophylline in a huge syringe IVpush-very slowly! Scary!

I'm sure I'll think of more later.

[Medic04]

Lets see as a Paramedic

we never wore gloves in the begining

We used to have to hold strips to a bottle to determine D stick to see what color was on the strip that matched the bottle.

We had no pre mixed drugs. You had to mix your own, know the values off the top of you head and do math all at once. Everything was to "gravity"

We had no pulse ox or CO2 indicator when tubing someone.

Blood was to be expected. There were times I was cover in it, and was not allowed to go change.

There really were no "needle boxes" at first.

Man I could go on and on......Wow how times changed.

[ebear, BSN, RN]

plumrn,

I remember all of those things, too!

Also: Mixing all of our own IV meds (not done by pharmacy then)

Being REQUIRED to make rounds with every MD that came onto

the floor

Having plenty of help and finishing work on time (usually)

In O.R., only counting sponges and sharps (scary!)

NEVER standing up to an MD for ANY reason!

Tolerating sexual harrassment from MD's with NO recourse!

White uniforms, hose and the required cap

Paper charts--no computers for ANYTHING

Knowing almost everybody in the hospital because staff stayed

for years

Administrators respected nurses highly

ebear

[Becca608]

:Santa3: I love this!!! Keep them coming!

I tried striping down an IV bag in clinical this semester and my professor looked at me like I was nuts! Seems that she didn't think they were teaching that in first year any more. Apparently they had discussed no longer teaching that technique, but decided that they had better continue after Hurricane Katrina.

[TazziRN, RN]

3 days in traction before femur fxs were ORIF'd. MI pts pre-thrombolytics. Thrombolytics for MIs before cath labs. Gardner-Wells tongs. Closed fx reductions pre-conscious sedation resulting in screaming pts. Staying in the hospital 5 days after vag deliveries. Staying in the hospital 24 hours after vag deliveries. Babies spent most of their time in the newborn nursery. Dads waited in the waiting room during deliveries. Dads couldn't go into the delivery room unless they had taken prenatal classes and watched The Movie. Moms were knocked out and shaved and enema'd and tied down for deliveries.

[ebear, BSN, RN]

You know what? I'll bet if the crap ever hits the fan and we don't have all the luxuries, an experienced nurse who could actually take care of a patient with nothing to rely on (as far as equipment) will be a valuable commodity. Years ago, a good nurse could actually tell what was going on with a patient with only observation skills and NO MONITORS!

[Ruby Vee, BSN]

abg syringes were glass. they were sterilized between uses.

mannitol came in crystallized form in a gigantic ampule that you heated gently in a pot of water on the stove (all nursing units had stoves), then sawed open with a file before drawing it up.

no gloves -- one box was kept on the floor for the interns to use when they did their rectal exams.

everyone smoked at the nurse's station, the break room, patient rooms, and even (some folks, anyway) while passing meds.

we took our catholic patients to mass every sunday. (protestant hospital. i'm sure the catholic hospitals still do this.)

only one ct scanner in town, so if your patient needed a ct, you got into an ambo with them and rode to the university hospital for their ct scan.

double bagging -- does anyone do that anymore?

patients and family members were pleasant to the nurse and grateful for their care. families brought in food for the nursing staff all during the month of december and for other holidays as well. families even brought in food because they were so grateful for you taking care of their loved one!

doctors were always right -- even when one chased you down the hall trying to throw a (full) bedpan at you, they were right.

calculating cardiac outputs and indexes by long division. doing drug calculations in your head. no one carried calculators because they were about the size of your defibrillator and hideously expensive.

[danissa, LPN, LVN]

plumrn,

I remember all of those things, too!

Also: Mixing all of our own IV meds (not done by pharmacy then)

ebear

ebear...we STILL mix our IV meds over the weekend..pharmacy is closed!

[RNDreamer]

For those of you who were nurses at a time when gloves weren't required, how was it to make that transition to use gloves? Was the idea to start using gloves reject at first or was it a relief that it was required? Thanks in advance.

[TazziRN, RN]

In terms of cleaning incontinent pts, being able to wear gloves was a relief. Starting IVs.....I learned to start them without gloves, so I was never able to get the feel of starting them WITH gloves.

[Medic04]

For those of you who were nurses at a time when gloves weren't required, how was it to make that transition to use gloves? Was the idea to start using gloves reject at first or was it a relief that it was required? Thanks in advance.

I was in a nursing home for a bit as a aid and the admin was not happy to comply. They screamed "cost" when asked to make sure to supply them:uhoh3:

As a Medic, I say yes it was a bit of a time to get used to them, not much was known about bloodborne ickys then and it was just another night at work and it washed off. Later it was pretty much accepted, tho some folks went screaming and kicking. Still when things are tight, I have to remember to wear them cause more then once I have caught myself trying to do Ivs and other things without them.

Like so many out there, from using the Latex ones so much over the years i have developed a allergy.:uhoh21: